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Many with diabetes missing out on statins

MONDAY, Sept. 12, 2016 -- Nearly all
middle-aged patients with diabetes should be taking cholesterol-lowering
statins, but cardiologists fail to prescribe these medications for 2
out of every 5 diabetics in their care, a new study finds.

Multiple prior studies have
shown that diabetics have a lower risk of heart attack and stroke if
they take a statin, even those with no history of heart problems, said
senior study author Dr. Salim Virani, a cardiologist at the Michael E.
DeBakey VA Medical Center in Houston.

"That's not debatable at this point," said
Virani, who is also an associate professor at Baylor College of
Medicine. "They should all be on statins."

But analysis of data from 204 cardiology
practices across the United States revealed that 38 percent of
middle-aged diabetics have not been prescribed statins.

The American College of Cardiology, the
American Heart Association and the American Diabetes Association have
issued recommendations that anyone aged 40 and older with diabetes be
prescribed statins.

Dr. Robert Eckel, past president of the
American Heart Association, said the statin treatment gap uncovered by
Virani and colleagues is "more dramatic than I expected."

"I perhaps thought 15 or 20 percent of
patients with diabetes would not be on statin therapy," said Eckel, who
is chair of atherosclerosis for the University of Colorado School of
Medicine. "This is almost 40 percent. That's unacceptable."

Worse, there appears to be a great deal of randomness in who gets prescribed a statin, the study found.

The researchers discovered a 57 percent
variation in statin prescribing practices, even after accounting for
individual patient factors such as age, gender, race, high blood
pressure, high cholesterol, tobacco use and insurance coverage.

In other words, if you take two identical
patients receiving care at two different cardiology practices, one is 57
percent more likely to be prescribed statins than the other.

By comparison, an earlier analysis of statin
use among similar patients within the VA health care system showed only
20 percent variation in prescriptions. Virani said that's likely because
VA doctors have uniform protocols and shared electronic health records,
which produces more consistent care compared to individual cardiology
practices.

For this study, researchers analyzed records
of 215,193 patients with diabetes but no overt heart disease who visited
a cardiologist between May 2008 and October 2013. They were aged 40 to
75.

The researchers found that only about 62 percent of middle-aged diabetics were prescribed a statin.

Those prescribed statins were more likely to
have risk factors that endangered their heart health, the study reports.
Further, they also were more likely to receive non-statin
cholesterol-lowering therapy (28 percent versus 13 percent for people
not receiving a statin) and had lower mean LDL "bad" cholesterol
readings (90 mg/dL versus 103 mg/dL).

There are some patients who aren't prescribed
statins due to side effects like muscle aches and pains, Virani said.
Anticipating this, the researchers removed 5,722 patients from their
analysis who had documented statin intolerance in their medical records.

Undocumented statin intolerance might account
for some of the patients who did not receive a statin in the final
analysis, but not many or most, Virani said.

Statin side effects can be handled without taking a patient off the drug completely, Virani added.

"A lot of these patients can be switched over
to a different statin, especially if a health-care provider can have a
discussion about the benefits of taking it," he said.

Many of these patients likely don't get the
statin prescription they need because their busy doctor is focused
solely on the medical issue that brought the two together that day,
Virani said.

"We have to take the time to close the loop
and make sure we're not just treating them for the current problem, but
also what we can do to reduce their risk of heart attack or stroke in
the future," he said.

There's one bit of good news from this study, Eckel noted -- the percentage of diabetics on statins is growing gradually.

"The good news is the trend is increasing, but
it's not as exponential as we'd like to see it," Eckel said. "It's a
gradual upward slope, in terms of patients receiving statins."

The study, which was funded through an
American Medical Association Foundation seed grant, was published online
Sept. 12 in the Journal of the American College of Cardiology.